Environmental Management for the Safety of Psychiatric Patients: The Challenging Role of Nurses
Keywords:
psychiatric ward, environment, safetyAbstract
A psychiatric ward is a facility that provides overnight care for patients with mental health issues, particularly those whose symptoms may pose a risk to themselves or others. Therefore, it is essential that these wards are designed with safety for psychiatric patients.
This article aims to demonstrate how environmental management is vital for the safety of psychiatric patients, helping to mitigate significant risks commonly encountered in psychiatric care. The key risks include: 1) Risk of suicide and self-harm. 2) Risk of aggressive behavior 3) Risk of escape. Managing the environment for safety is a significant and challenging role of nurses in finding crucial measures to care for and prevent potential harm to psychiatric patients.
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Thanattheerakul C. Environmental theory: A legacy in nursing profession. Nursing Science and Health Journal. 2018;41(1):149-57. (in Thai)
Bureau of Policy and Strategy, Department of Health Service Support, Ministry of Public Health. Handbook for the design of healthcare service buildings and ward environments. Bangkok: Ministry of Public Health; 2015. (in Thai)
Liu AJ, Im DS, & Hirshbein LD. What does the history of inpatient psychiatric unit design tell us about balancing safety and healing for patients with suicidal behaviors?. AMA Journal of Ethics. 2024;26(3):E257-63.
Žaludek A, David J, Kajzar J, & Marx D. Safe environment management in acute psychiatric wards in the Czech Republic, foundation for recommendations for preventive practice. Central European Journal of Public Health. 2021;29(3):217-22.
Phanthusat N, & Thongyu R. Nursing practice guidelines according to patient safety standards. Thai Red Cross Nursing Journal. 2017;10(2):1-13. (in Thai)
Department of Mental Health, Ministry of Public Health. Guidelines for the establishment of psychiatric and drug addiction wards for regional and general hospitals. 1st ed. Bangkok: Chotika Business Print Co.; 2021. (in Thai)
Williams SC, Schmaltz SP, Castro GM, & Baker DW. Incidence and method of suicide in hospitals in the United States. The Joint Commission Journal on Quality and Patient Safety. 2018;44(11):643-50.
Kongsuk T, Arunpongpaisal S, Chantarang S, Prueksanan B, Sukawadee S, & Leejongpumpoon J. Criterion validity of the 9-question depression scale, revised version in Central Thai language. Journal of the Psychiatric Association of Thailand. 2018;63(4):321-34. (in Thai)
Dome P, Rihmer Z, & Gonda X. Suicide risk in bipolar disorder: A brief review. Medicina. 2019;55(8):403-10.
Bareis N, Olfson M, Gerhard T, Rolin S, & Stroup TS. Means of suicide among adults with schizophrenia across the life span. Schizophrenia Research. 2023;251:82-90.
Khamma A. Risk factors associated with suicide: a case-control study in Sukhothai province. Journal of the Psychiatric Association of Thailand. 2013;58(1):3-16. (in Thai)
Sukhawaha S, & Arunpongpaisal S. Risk factors and suicide theory associated with suicide in adolescents: a narrative review. Journal of the Psychiatric Association of Thailand. 2017; 62(4):359-78. (in Thai)
Al Ishaq M, Amie MH, Al Swaidi SJ, & Abdallah NH. Patient safety procedure in mental health services: a review article. NILES Journal for Geriatric and Gerontology. 2023;6(1):353–92.
Weltens I, Bak M, Verhagen S, Vandenberk E, Domen P, van Amelsvoort T, et al. Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of literature. PLoS ONE. 2021;16(10):e0258346.
Sriyarat K. Nurses’ roles in management of aggressive psychiatric patients. Thai Red Cross Nursing Journal. 2015;81(1):43-52. (in Thai)
Mental Health Service System Administration Division, Ministry of Public Health. Guidelines for the care of emergency psychiatric patients (acute care) for public health service units (Levels A, S, M1, and M2) trial edition. 2nd ed. Bangkok: Beyond Publishing Company; 2023. (in Thai)
Rund BR. The association between schizophrenia and violence. Schizophrenia Research. 2018; 199:39-40.
Camus D, Dan Glauser ES, Gholamrezaee M, Gasser J, & Moulin V. Factors associated with repetitive violent behavior of psychiatric inpatients. Psychiatry Research. 2021;296: 113643.
Chuanchanok W, Bhatarasakoon P, & Skulphan S. Factors related to aggressive behavior of patients with schizophrenia at emergency psychiatric departments. Journal of Psychiatric and Mental Health Nursing. 2022;36(3):81-97. (in Thai)
Singhakant S. Aggressive and violent behavior. Siriraj psychiatry DSM-5. Bangkok: Prayoon Sarn Thai Printing; 2015. p.117-20. (in Thai)
The Healthcare Accreditation Institute (Public Organization). People safety goal: SIMPLE Thailand 2024. Nonthaburi: Sahamit Printing and Publishing; 2024 (in Thai)
Ulrich RS, Bogren L, Gardiner SK, & Lundin S. Psychiatric ward design can reduce aggressive behavior. Journal of Environmental Psychology. 2018;57:53–66.
The Joint Commission. De escalation in health care. Quick Safety. 2019; 28;(47):1–4.
Verma DK, Khanra S, Goyal N, Das B, Khess CRJ, Munda SK, et al. Absconding during Inpatient care from a tertiary psychiatric hospital: a comparative study. Indian Journal of Psychological Medicine. 2020;42(5):456-63.
Kittilaksanon P, Gunadhivadhana P, & Aksorn S. The development of clinical risk management system: prevention and management of patient elopement in the adult psychiatric services under the department of mental health in the fiscal year 2018-2019. Academic Psychiatry and Psychology Journal. 2021; 37(2):145–57. (in Thai)
Kirchebner J, Lau S, & Sonnweber M. Escape and absconding among offenders with schizophrenia spectrum disorder-an explorative analysis of characteristics. BMC Psychiatry. 2021;21(1):122-32.
Inkaew S, Chaiyinhu R, Kittiraksanont P, & Pabaralit S. Guidelines for the prevention and management of patient escape in psychiatric institutions/hospitals under the Department of Mental Health (1st revision). Division of Mental Health Service Administration, Department of Mental Health, Ministry of Public Health; 2018. (in Thai)
Campagnolo D, Furimsky I, & Chaimowitz GA. Absconsion from forensic psychiatric institutions: a review of the literature. International Journal of Risk and Recovery. 2019;2(2):36–50.
Reuben A, Manczak EM, Cabrera LY, Alegria M, Bucher ML, Freeman EC, et al. The interplay of environmental exposures and mental health: setting an agenda. Environmental Health Perspectives. 2022;130(2):025001.
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